Monday, August 31

Vince Nastri III paid $9,000 for the coffee machine he installed in his lower Manhattan tobacco shop. Now it could cost him thousands of dollars more. The city's health department is threatening him with fines, saying he is operating a "food-service establishment" without a permit, even though the coffee is free. Nastri could apply for a permit, but then his customers would no longer be allowed to smoke.

You have three options for who gets to choose whether the marginal benefit of a given medical treatment or health insurance benefit is worth the marginal cost. I think of them as “levels”:

government;

insurers & employers; and

you (with advice from your doctor).

They key analytic point is that whoever controls the money makes the decision. To oversimplify, the higher you push the decision, the more you can redistribute among people. The lower you push the decision, the more efficient you are. I think that certain political realities also will affect the total amount of resources dedicated to health care, depending on at which level the decisions are made.

Nearly a year after announcing the plan, new Federal Trade Commission rules prohibiting most robocalls are set to take effect Tuesday, Sept. 1. With the rules, prerecorded commercial telemarketing robocalls will be prohibited, unless the telemarketer has obtained permission in writing from consumers who want to receive such calls. Hopefully the rules will go a long way to helping consumers eat dinner in peace without being interrupted by amazingly annoying telemarketer blather or in this case prerecorded blather. The requirement is part of amendments to the agency's Telemarketing Sales Rule (TSR) that were announced a year ago. After September 1, sellers and telemarketers who transmit prerecorded messages to consumers who have not agreed in writing to accept such messages will face penalties of up to $16,000 per call.

However:

..for those who have called on the FTC to help eliminate the other phone scourge - political robocalls - the new rules will not help. Calls from political campaigns are considered protected speech the FTC said. Ultimately consumers may get some help from state legislatures as many are regulating or looking to pass laws for more control over automated or robocall computer-generated phone-calling campaigns. One group, the National Political Do Not Contact Registry is campaigning to outlaw political robocalling altogether.

People have an interest in not being harassed by misleading calls near election eve. I think a blanket or opt-in/out ban on political robocalls would be fair and equitable.

What I certainly could not tolerate would be something like McCain-Feingold's mockery of the First Amendment, dictating what some groups—including nonprofits—can and cannot say in their political speech. It's an unconstitutional and unconscionable affront to open democracy.

Are we ever going to retire the F-word? You know what I'm talking about: fascist. It seems that we can't go more than a few months without someone leveling this accusation at a president from the opposition party.

This is beyond moronic. The Bush administration did many bad things. But to call his administration fascist is both to completely abuse the term, and to belittle the millions of victims of fascism. Fascism is not just something of which you disapprove . . . nay, not even if that something involves the military. The things that the US did to its POWs can be very, very wrong without rising to the level of the Gestapo. And if you think that they are even close, I suggest that you reread the reports, and then go read some history of the Gestapo. Afterwards, tell me that you would be indifferent to being a captive of Nazi Germany or the US. Tell me whether you'd rather be a citizen of Iraq or Nazi-era Poland. That we even have to discuss this is ridiculous.

Similarly, the fact that Hitler liked government health care is really totally irrelevant to this discussion, thank you so much for not bringing it up. Hitler also liked cream puffs and dogs. Shall we get rid of anyone who shows similar predilictions? Not all forms of state intervention in the economy are fascist. Fascism is a particular thing, not the amalgam of everything you happen not to like. It is an embarassment to the right that anyone would even think of saying something so awful, much less put an effing Hitler moustache on a photograph of the man who is, when all is said and done, the president of the country you claim to love so much. Your fellow citizens elected him. Show some respect, if not to Obama, then to democracy.

Would it be too, too trite to say that some days I despair? Because I really do.

By insisting that politicians are motivated by considerations no different than businessmen or anybody else, public choice economists have helped slay the pernicious myth that politicians are generally warmly other-regarding public servants. But the economist’s assumption of motivational uniformity fails to capture that politicians do in fact seem to be really odd people who don’t seem to be primarily motivated by the same considerations that motivate most of us most of the time. The incentives of the political process create a kind of filter that selects for individuals extraordinarily fixated on power and status and extraordinarily motivated to keep it. If this is right (anyone know of personality studies of politicans?), then the problem with standard public choice is that it gives too much credit to politicians by assuming they’re like everyone else and therefore it fails to capture just how exceptionally prone politicians are to narcissism, motivated cognition, self-deception, and brazen lying.

But the procedure is only "controversial" because people have emotional, psychological and religious reactions to it. Scientifically speaking, it's not remotely controversial [..] compelling studies emerged about the role circumcision plays in reducing the risk for transmission of HIV and other STD's

Scientifically speaking?! Well, it also removes sensitive nerve endings, muscle fibers, and blood vessels that are part of normal sexual sensation.

Be that as it may, why aren't we human rights speaking?

Mutilating babies before they've even learned to speak, much less reached an age of consent, is an outrageous violation of their rights.

You know what might be even more effective for reducing the risk for transmission of HIV and other STDs? Just cut the whole thing off and rely on artificial insemination later in life. Why don't we put infants through that too, huh?

I have zero problem with medical alterations once a person is sexually mature and can consent to the procedure. But these are helpless children we're talking about! Are we so barbaric?

If we must provide waivers for some parents in the name of religious freedom, I can tolerate that. At least it will be clear it's their religion condoning the barbarism. But apart from such an exception, circumcising children should be a crime.

"Only one crime was solved for each 1,000 CCTV cameras in London last year, a report into the city's surveillance network has claimed. The internal police report found the million-plus cameras in London rarely help catch criminals. In one month CCTV helped capture just eight out of 269 suspected robbers. David Davis MP, the former shadow home secretary, said: 'It should provoke a long overdue rethink on where the crime prevention budget is being spent.' He added: 'CCTV leads to massive expense and minimum effectiveness. It creates a huge intrusion on privacy, yet provides little or no improvement in security. The Metropolitan Police has been extraordinarily slow to act to deal with the ineffectiveness of CCTV.'"

since 1945 in Europe and the Americas, we’ve seen steep declines in the number of deaths from interstate wars, ethnic riots, and military coups, even in South America. Worldwide, the number of battle deaths has fallen from 65,000 per conflict per year to less than 2,000 deaths in this decade. Since the end of the Cold War in the early 1990s, we have seen fewer civil wars, a 90 percent reduction in the number of deaths by genocide, and even a reversal in the 1960s-era uptick in violent crime.

First time viewers of this display invariably do not see the 16 circles segmented from the background. Rather, they see a series of rectangles that they frequently describe as “door panels”. The illusion pits segmentation cues against what appears to be a very strong prior to interpret the image as a series of 3-D structures “coffers” with closed boundaries. (A coffer is a decorative sunken panel.) It appears that the prior involves both closure and shape-from shading assumptions.

[..] I wish to avoid drowning in weak man arguments. The majority of the partisan blogosphere pretty much runs on weak mans. A progressive will pull some ludicrous position or quote from a conservative to ridicule with her buddies, and vice versa. Subtext being: "of course we have to fight those people—they're all insane!". It becomes a snarky, smug, morale-boosting sport. One that in the past I've dabbled in often—albeit from my own pox on both your houses perspective.

As a contemporary example, Cato argues Cash for Clunkers is among the dumbest ever:

A few billion dollars worth of wealth was destroyed. About 750,000 cars, many of which could have provided consumer value for many years, were thrown in the trash. Suppose each clunker was worth $3,000 at a guess, that would mean that the government destroyed $2.25 billion of value.

Low-income families, who tend to buy used cars, were harmed because the clunkers program will push up used car prices.

Taxpayers were ripped off $3 billion. The government took my money to give to people who will buy new cars that are much nicer than mine!

The federal bureaucracy has added 1,100 people to handle all the clunker administration. Again, taxpayers are the losers.

The auto industry received a short-term “sugar high” at the expense of lower future sales when the program is over. The program apparently boosted sales by about 750,000 cars this year, but that probably means that sales over the next few years will be about 750,000 lower. The program probably further damaged the longer-term prospects of auto dealers and automakers by diverting their attention from market fundamentals in the scramble for federal cash.

Sane folks should agree these outcomes are outrageously dumb. B-b-but, Obama bragged the program was popular! And truly, it was.

Offering everyone $100 towards burning an old set of ugly clothes and buying a sleek new replacement might also prove popular, both to consumers and the clothing industry. Huzzah, let's do it! Regrettably, such popularity does not make it a good idea nor mean that implementing it would make any kind of economic or environmental sense—which it clearly wouldn't.

This basic problem of economic inefficiency, generalized, is why the majority of other government programs and economic interventions are also really bad ideas. What is politically popular seldom implies economic efficiency. Often, quite the contrary. Political popularity foments fiscal insanity. First you get your Democrats, who want to give every person on Earth a free cake, dog, and pony—plus the choice of a prepaid subscription to either People or The Washington Monthly. This proves popular. Then as a reaction you get your Republicans, who don't want to pay half a cent toward anything. This also proves popular. Unsurprisingly, voters want to have their cake and not have to pay for it, too. Politicians are happy to pander to both sides. The emerging compromise? Massive deficits—a.k.a. having our children and grandchildren deal with it somewhere down the line.

Yes, Virginia—I don't mean to scare you with technical phrasing, but politics and government really do suck.

A sufficiently free market, by contrast, implements a method that almost always results in superior efficiency to either political popularity or technocratic fiat. It's called price signals.

Unfortunately, due to a history of misguided (but politically popular!) government interventions and regulation, the U.S. health-care system does not have price signals. This works out very poorly.

Allow me to paint you an analogy. It would be as if credit cards were issued by "insurance card" companies who agree to provide their customers with "consumption coverage". You would pay them a pre-arranged monthly "consumption premium", and in exchange they would "cover"—with just a small co-pay!—any shopping you do with their card, provided it was clear that you "needed" it. Ramen noodles would probably be covered—eat more than you can puke. So would most canned goods. Even many of the cheaper fruits and veggies. But the fine entrée you wanted to serve at your next dinner party? Sorry, your insurance card company doesn't think you "need" it. Oh, and there would also be limits on things like how much gas you can buy per week or how many drinks you're allowed at the bar per night. Sound good? Meanwhile, more and better ways would be developed to game and profit off the convoluted system. Retailers would overcharge whatever they could get away with making the "insurance card" companies pay, and consumer demand for more and better purchase coverage would rapidly increase. Thus the monthly cost of these "consumption premiums" would also soar.

The above scenario is basically the status quo of U.S. health-care. Obviously, it sucks. In lieu of price signals, people always want more and better health-care to be provided, just like in the above they always want more "consumption coverage". When the consumer doesn't pay for services, markets become dysfunctional. (Also true of some marriages >_>)

So how to reform the system? Apart from those unfortunate Brits—who tragically got the idea during WWII that it would be good for their state to stay in the business of directly providing care—the left's favored solution tends to be single-payer: a government takeover of health insurance companies, analogous to taking over the odd "insurance card" ones above.

Insurance companies make great villains, but as we saw with Cash for Clunkers and can observe by looking at many other programs—particularly socialized health plans in other countries—they all have their own kinds of problems. These problems are different from the US status quo: better in some ways, worse in others.

For example, one thing other countries' socialized systems are better at is cost control (.pdf). They use their monopsony power to negotiate lower prices, and they can often be better at saying no to consumers. They say no in more equitable ways, such as long waiting times, and some Canadian towns run regular lotteries to decide which families get a doctor.

Controlling costs would be nice, especially compared to an expensive system like the US status quo. But one thing centralized bureaucratic cost controls also do is reduce the incentive for future private innovation. Why spend your time experimenting with and further developing a new health product if you can't know whether the health bureau will decide it's a cheap and effective enough treatment to get it off the ground?

In short, the choice between the U.S. status quo and a single-payer system offers trade-offs. I won't spill more ink trying to formally pin them all down: it's a big topic, kind of like going on about the difference between Republicans and Democrats.

At this point someone usually pipes up and wails about the plight of the uninsured poor. But that is not a health-care system problem, it is an income problem. And one of the few ways to directly mitigate an income problem is to provide subsidies to low-income families (some ways are more economically sound than others). Point is, you could implement subsidies and attain universal health insurance coverage in the U.S. without directly changing anything about our health-care delivery system or the insurance companies themselves. It would just be really expensive and balloon either the deficit or tax rates, which is why it shouldn't be done in isolation.

Happily there's a reform that would lower costsfor everyone while actually increasing innovation: bring back the price signals that are so essential to market efficiency. Here's how this might be accomplished:

Firstly, repeal any state-level regulation—often called "patients bill of rights"—that require insurance companies to fully cover particular procedures or put an artificial ceiling on deductibles. This would clear the regulatory barriers for health plans that sport low premiums and high deductibles, suitable for catastrophic coverage only. This is how real insurance is supposed to work, like the kind we have for our cars and homes. By contrast, the sort of thing we call "health insurance" today is actually "pre-paid health care". Just imagine how high your car insurance payments would be if it were required to cover 80% of the cost of oil changes, tire rotation, wiper blades, new tires, regular service, etc.

Of course, esteemed Nobel laureates like Paul Krugman shall protest: "Health care is not a bowl of cherries...or a carton of milk, or a loaf of bread."

Indeed, shopping for health-care probably sounds like an odd idea to most. But HSAs have been tried right here in America, and the data suggest they work well:

Consumer-driven health (CDH) products [i.e., high-deductible health plans relying on HSAs or Health Reimbursement Arrangements to reimburse for qualified expenses] have been marketed in various forms since the early 2000s. While emerging data is [sic] not entirely conclusive, general directional conclusions can be drawn from the studies published to date. […]

With regard to first-year cost savings, all studies showed a favorable effect on cost in the first year of a CDH plan. CDHplan trends ranged from -4 percent to -15 percent. Coupled with a control population on traditional plans that experienced trends of +8 percent to +9 percent, the total savings generated could be as much as 12 percent to 20 percent in the first year. All studies used some variation of normalization or control groups to account for selection bias.

For savings after the first year, at least two of the studies indicate trend rates lower than traditional PPO plans by approximately 3 percent to 5 percent. If these lower trends can be further validated, it will represent a substantial cost-reduction strategy for employers and employees.

Generally, all of the studies indicated that cost savings did not result from avoidance of appropriate care and that necessary care was received in equal or greater degrees relative to traditional plans. All of the studies reviewed reported a significant increase in preventive services for CDH participants. Three of the studies found that CDH plan participants received recommended care for chronic conditions at the same or higher level than traditional (non-CDH) plan participants. Two studies reported a higher incidence of physicians following evidence-based care protocols.

Bottom lines: the status quo puts health care rationing in the hands of insurance companies. Single-payer puts rationing in the hands of bureaucrats. A free, CDH market places it in the hands of consumers.

Which of the three do you prefer?

Contrary to popular belief, those of us on the economic right do not advocate market solutions because we have some arcane faith in mythical powers of the market. We do so because they actually work better—even when they're politically unpopular.

(At this point someone usually pipes up to rail about how the financial crisis, like, totally discredits the idea of markets being better. Let's try not to be distracted by this different, macroeconomic topic that has more to do with a combination of poor regulation and lack of understanding the business cycle.)

The mean socially conservative Republican voter is our useful idiot. They don't understand free market economics any better than the left does, and are liable to show up at your local town halls spouting all sorts of nonsense about government conspiracies to kill more babies. But the socons are willing to vote with us, so we often have to hold our nose and work with them. It's called fusionism, and it's been the price to pay for an economic way of doing business that—while superior on the merits—would otherwise be too politically unpopular. See for example the situation in contemporary Europe, which unlike the US has managed to purge socon fervor the old-fashioned way: through a long, tragic history of disastrous war.

I deplore social conservative attacks on personal freedom as much as the next freethinker, and I aim to counter them. But I also deplore the left's attacks on economic freedom. And I'm aware of the uncomfortable truth: unless I can convince a lot more of my fellow social liberals to cut back on their leftism and support freer markets, a chronic Faustian bargain with socons is necessary to preserve what economic freedoms we have. Without this bargain, the U.S. economy would become more like Europe's, with the lower efficiency and lowered growth that over the long term is worse for everyone—rich and poor alike. Unless, of course, one is lucky enough to become a politician, bureaucrat, or have a personal connection to the business. Then the European political-economic landscape looks pretty rosy, and one can seek out all sorts of creative ways to gloss over the underlying economic inefficiency.

Friday, August 21

That Obama could simply roll into Washington and ignore the myriad forces arrayed against a liberal agenda? That conservatives, Republicans, moderate Democrats, and interested industry groups would simply go away or shut up? That Obama, through force of will and liberal coolness, could use his awesome rhetorical ju-jujitsu skills to flip the opposition and defeat nutty right-wingers and conservative politicians forever?

Unless you're a character in an Aaron Sorkin show, that's just not how national politics work.

WASHINGTON — Tom Ridge, the first secretary of homeland security, asserts in a new book that he was pressured by top advisers to President George W. Bush to raise the national threat level just before the 2004 election in what he suspected was an effort to influence the vote.

After Osama bin Laden released a threatening videotape four days before the election, Attorney General John Ashcroft and Defense Secretary Donald H. Rumsfeld pushed Mr. Ridge to elevate the public threat posture but he refused, according to the book. Mr. Ridge calls it a “dramatic and inconceivable” event that “proved most troublesome” and reinforced his decision to resign.

The provocative allegation provides fresh ammunition for critics who have accused the Bush administration of politicizing national security. Mr. Bush and his Democratic challenger, Senator John Kerry of Massachusetts, were locked in a tight race heading into that final weekend, and some analysts concluded that even without a higher threat level, the bin Laden tape helped the president win re-election by reminding voters of the danger of Al Qaeda.

Fearmongering alert level: PANIC (High risk of losing re-election).

Other than this nefarious political effect, I never understood how people could think the Homeland Security alert system useful. Doesn't it run counter to the whole idea of, ehm, not allowing terrorism to terrorize us?

John McCain’s August 29 announcement of Palin as his running mate surprised the Republican establishment, the media, and especially voters. She made a strong first impression: she enjoyed high approval ratings after her acceptance speech, and the percentage of voters saying that they intended to vote Republican skyrocketed. But within days of the speech, her ratings began a precipitous slide from which she—and the McCain campaign—never recovered. Throughout the rest of the campaign, vote intentions were closely tied to Palin’s approval ratings: each major Palin approval drop was followed, within a day or two, by a drop in McCain vote intention. No other factor moved McCain support with such precision.

However, conservatives have a well-earned reputation for ignoring reality, especially in recent years. So don't hold your breath.

The NY Times reports that it is possible to fabricate blood and saliva samples containing DNA from a person other than the donor, and even to construct a sample of DNA to match someone's profile without obtaining any tissue from that person — if you have access to their DNA profile in a database. This undermines the credibility of what has been considered the gold standard of proof in criminal cases. 'You can just engineer a crime scene,' said Dan Frumkin, lead author of the paper. 'Any biology undergraduate could perform this.' The scientists fabricated DNA samples in two ways. One requires a real, if tiny, DNA sample, perhaps from a strand of hair or a drinking cup. They amplified the tiny sample into a large quantity of DNA using a standard technique called whole genome amplification. The other technique relies on DNA profiles, stored in law enforcement databases as a series of numbers and letters corresponding to variations at 13 spots in a person's genome. The scientists cloned tiny DNA snippets representing the common variants at each spot, creating a library of such snippets. To prepare a phony DNA sample matching any profile, they just mixed the proper snippets together. Tania Simoncelli, science adviser to the American Civil Liberties Union, says the findings were worrisome. 'DNA is a lot easier to plant at a crime scene than fingerprints,' says Simoncelli. 'We're creating a criminal justice system that is increasingly relying on this technology.'

WASHINGTON—After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care.

"Both parties understand that the current system is broken," House Speaker Nancy Pelosi told reporters Monday. "But what we can't seem to agree upon is how to best keep it broken, while still ensuring that no elected official takes any political risk whatsoever. It’s a very complicated issue."

The legislative stalemate largely stems from competing ideologies deeply rooted along party lines. Democrats want to create a government-run system for not providing health care, while Republicans say coverage is best denied by allowing private insurers to make it unaffordable for as many citizens as possible.

There's an old Borges short story called "The Library of Babel," about mythical library that contains all possible 410-page books. I mention this only because I'm pretty certain that the Internet has now produced all possible blog posts on the subject of a public option -- and, more specifically, the death of the public option.

[..] there's no reason to turn a public option into a political fetish.

Interventionism cannot be considered as an economic system destined to stay. It is a method for the transformation of capitalism into socialism by a series of successive steps.

There are only middle-of-the-roaders who think they have been successful when they have delayed for some time an especially ruinous measure. They are always in retreat. They put up today with measures which only ten or twenty years ago they would have considered as undiscussable. They will in a few years acquiesce in other measures which they today consider as simply out of the question.

Sunday, August 16

An Afghan bill allowing a husband to starve his wife if she refuses to have sex has been published in the official gazette and become law.

[..] It allows a man to withhold food from his wife if she refuses his sexual demands; a woman must get her husband's permission to work; and fathers and grandfathers are given exclusive custody of children.

Democrats argue that a Public Option won't crowd out private health insurance. It will just give them "healthy" competition. I'm skeptical, in large part because the government can and will simply legislate away the normal aspects of competition (the need to balance the books, to make cost/benefit calculations, and to negotiate on price/quality, rather than on "...or else we'll regulate you into submission"). Policies designed to keep down health care spending will not survive against politicians up for reelection.

The people responsible for Trillion dollar deficits are unlikely to usher in an era of health care spending restraint.

A public insurance plan able to use Medicare's bargaining power to secure deep discounts for its customers and ensure the maximum possible network would be cheaper and more efficient than private insurers. Over time, this increased efficiency would make the plan more attractive because it could offer more coverage for less money. As consumers recognized this fact, they would increasingly migrate towards the plan, and the public insurer would become, if not a de factosingle payer system, something close to it. The public insurer, in this scenario, is a game changer. [...] Insurers, predictably, howled that a public insurer with access to Medicare's market power would put them out of business. (Generally speaking, liberals agreed with that.)

Still other Democrats have pointed to the education system as an example of universal coverage with private alternatives. On Twitter, Pandagon's Jesse Taylor argued that a Public Option wouldn't affect private insurance...

What healthcare choice can you exercise right now that a.) would be gone under a public option and b.) couldn't be taken away currently?

Politicians who make this argument should be confronted with this question: What school choice can you exercise right now that would be gone if we had vouchers and school choice for everybody?

Democrats refuse to level the playing field between the public and private options in education. They will do the same thing in health care.

In this 1941 propaganda cartoon produced by the Treasury Department, Donald Duck is told that it's not just his duty to pay his income taxes, it's a "privilege." This was right before mandatory income tax withholding was legislated, so I guess the government had to use propaganda to help convince Americans that they needed to save money to pay their income taxes.

Although it might have been slightly exaggerated in the cartoon, notice that Donald Duck fills out a simple one-page income tax form that could easily be completed in several minutes. Also, notice that because it was in the pre-withholding era, he actually writes out a personal check for $13, payable to the Internal Revenue Service. Ahhhhhhhh.....the good old days.

[..] ultimately, if the president decides that he's going to go with a reform effort that doesn't include a public option, what he will have done is spent a ton of political capital, riled up an incredibly angry right wing base who's been told that this is a plot to kill grandma, grandma, and he will have achieved something that doesn't change health care very much and that doesn't save us very much money and won't do very much for the American people. It's not a very good thing to spend a lot of political capital on.

The public option is not now, and has not ever, been the core of the argument for heath-care reform. It is the core of the fight in Washington, D.C. It is an important policy experiment. But it was not in Howard Dean or John Kerry or Dick Gephardt's plans, and reformers supported those. It was not in Bill Clinton's proposal, and most lament the death of that. It is not what politicians were using in their speeches five years ago. It is a recent addition to the debate, and a good one. But it is not the reason were are having this debate.

Of course Ezra thinks the public option is a good idea because, like so many on the progressive left, he supports single-payer and anything that moves us in that direction.

But at least he's cognizant that other aspects of reform are much more important than this "policy experiment".

I assume a significant number of those opposed are doing so for incoherent reasons, e.g. buying into the FUD spread by Republicans.

Thankfully this is a Republic, not a direct Democracy, so there is a reasonable chance public opposition will moderate the bill in positive ways, such as axing the public plan that most people actually support (because they don't understand the implications--it's being sold as merely an additional "option")

There is also a good chance public opposition will cause the eventual bill to become an even worse crap sandwich--with more giveaways to special interests ala Waxman-Markey.

And I see a small outside chance the opposition will lead to scrapping the current bill and starting from scratch with a superior approach like Wyden-Bennett.

Ah, sweet legislative uncertainty. This calls for a market-based solution! Here's the intrade prediction for "A federal government run health insurance plan to be approved before midnight ET 31 Dec 2009"

Seems to me the media accounts of this story are missing the point. Yes, it’s amusing and a bit surreal to picture Bob Dylan wandering around a local neighborhood near where he’s giving a concert. But now everyone’s having a good laugh about how two local police officers had no idea who Dylan was when they stopped and detained him after some residents reported an elderly man acting “suspiciously.”

I don’t know. I find it pretty depressing. There was a time when we condescendingly used the term “your papers, please” to distinguish ourselves from Eastern Block countries and other authoritarian states. Post-Hiibel, America has become a place where a harmless, 68-year-old man out on a stroll can be stopped, interrogated, detained, and forced to produce proof of identification to state authorities, despite having committed no crime.

Friday, August 14

[Washington State University neuroscientist Jaak Panksepp] says that humans can get just as excited about abstract rewards as tangible ones. He says that when we get thrilled about the world of ideas, about making intellectual connections, about divining meaning, it is the seeking circuits that are firing. The juice that fuels the seeking system is the neurotransmitter dopamine.

The dopamine circuits "promote states of eagerness and directed purpose," Panksepp writes. It's a state humans love to be in. So good does it feel that we seek out activities, or substances, that keep this system aroused—cocaine and amphetamines, drugs of stimulation, are particularly effective at stirring it.

Ever find yourself sitting down at the computer just for a second to find out what other movie you saw that actress in, only to look up and realize the search has led to an hour of Googling? Thank dopamine.

The trouble is that Democrats and liberals have become so closely associated with single-payer and government-run universal health insurance that people can’t comprehend that they’re now pushing for something substantially less than that, particularly when so many Democrats, the President included, have suggested that this is a step on the road to single-payer. Attempting to explain that the current leading proposals would not, in fact, be a single-payer system or “socialized medicine” is thus either difficult to believe or impossible to do well in a few sentences. Even where it can be done, there’s not really any way of credibly denying the “slippery slope” argument since so many liberals and Dem politicians have made clear that creating a slippery slope towards nationalized health insurance is precisely what this legislation is supposed to do.

Thursday, August 13

Because of various government intereferences, more than 1/3 of all health care spending is purely administrative. By contrast, Canada’s administrative burden on health care funding is about 1%. If we were to switch over to a single payer system, there is an excellent chance that we would, in fact, spend less money on health care than we currently do.

This doesn't address the prospect of decreased innovation in the cheaper single-payer system. But his prescriptions for reform are nonetheless good:

[..] there is a fundamental problem with our current debate. We are arguing over whether we should keep the system we have, or move to a system that sets us on the path to a single-payer system. But those aren’t the only alternatives. There is another option that is being lost in this debate. The Democrats don’t want to mention it for ideological reasons. The Republicans don’t mention it because of…well…incompetent buffoonery, I guess.

The alternative, of course, is to make the case that our current system costs so much, and is so distorted, because of government interference. We have a mixed system of health care funding in which the government’s intervention imposes a wide range of unnecessary costs. So our choice is not to keep what we have, or eliminate the administrative overhead by turning it all over to the government. The third choice is to return to a free market in health care.

Eliminate state by state coverage mandates, which result in 50 different–and sometimes wildly so–regulatory regimes. Eliminate federal and state laws that prevent insurers from creating nationwide plans and risk pools. Eliminate employer health-care coverage, and personalize it, to make it personal and portable.

Here’s another idea: allow people to buy health insurance. That isn’t what we have now. We have pre-paid health care. The two things are wildly different. For example, look at how auto insurance works. Imagine how much your car insurance would cost if we expected our insurance to cover 80% of the cost of oil changes, tire rotation, wiper blades, new tires, regular service, etc. But that’s precisely what we expect medical insurance to do. And then we wonder why it costs so darn much.

We need to allow insurers to offer simple catastrophic care coverage, with varying deductibles. That way, you can pick up the tab for your own doctor’s visits, but you don’t have to worry about bankrupting yourself if some idiot runs a stop sign and knocks you off of your motorcycle. We need to allow anyone who wants to set up a medical savings account. Heck, if we really want “the government” to finance it, we could offer a 100% tax credit for health care expenditures.

Stop me if this sounds vaguely familiar, but classic 1970s SF show Battlestar Galactica is returning to our screens. The original show ran for 24 episodes in 1978-79.

"Ha! Ha! A reremake? That's a good one."

"Er, we're not making this up."

Oh yes, and there was another TV series that ran for 80 episodes and five fricking years which finished less than five months ago for cryingoutloud and has a spin-off series called Caprica which doesn't even start until January.

What's interesting to me is he doesn't acknowledge that the same incrementalism / slippery-slope argument suggests the public option is a trojan horse for a more complete government takeover of the insurance industry--i.e. a Canadian-like single-payer or Medicare-for-all, which Ezra and the president also support (but acknowledge as still being politically infeasible).

Sen. Mendez (D-N.J.) introduced legislation Thursday that would allow federally-regulated online poker and other games of skill. The bill is designed to raise revenue while protecting families through a crackdown on predatory Internet gaming sites that target minors and fleece their customers. A 2006 law banned most forms of Internet gambling in the United States and some members have been trying to get the statute repealed or significantly modified.

WASHINGTON — In pursuing his proposed overhaul of the health care system, President Obama has consistently presented himself as aloof from the legislative fray, merely offering broad principles. Prominent among them is the creation of a strong, government-run insurance plan to compete with private insurers and press for lower costs.

Behind the scenes, however, Mr. Obama and his advisers have been quite active, sometimes negotiating deals with a degree of cold-eyed political realism potentially at odds with the president’s rhetoric.

[..] The [Senate] Finance Committee, for example, appears to be coalescing around the idea of nonprofit insurance cooperatives instead of a government-run plan. It is a proposal the health care industry prefers, but many liberal Democrats oppose, in both cases because cooperatives are likely to have less leverage over health care prices.

[..] [Chief of Staff Rahm Emanuel] also acknowledged the political realities that have made the Finance Committee’s still-unfinished cooperative plan a center of attention. “We have heard from both chambers that the House sees a public plan as essential for the final product, and the Senate believes it cannot pass it as constructed and a co-op is what they can do,” he said. “We are cognizant of that fact.”

Asked whether the president would accept the weaker co-op, Mr. Emanuel declined to comment. “I am not going to fast-forward the process,” he said.

[..] Mr. Obama and his top aides have immersed themselves in the Senate Finance Committee process. The president talks to Mr. Baucus several times a week, people briefed on their conversations say. Mr. Obama has also held a few calls with the panel’s ranking Republican, Senator Charles E. Grassley of Iowa.

In addition, Mr. Obama invited both senators to a private lunch at the White House early in the summer and met with six panel members for another White House session last week. White House advisers have held long evening and weekend meetings with Finance Committee staff members.

Nancy-Ann DeParle, charged with leading the White House health effort, has a standing biweekly meeting with Mr. Baucus, while Peter R. Orszag, the White House budget director, has spent so much time in the senator’s office that he helps himself to the Coke Zeros tucked away in Mr. Baucus’s personal refrigerator.

Lobbyists for the drug and hospital industries say that, as early as June, White House officials directed them to work out cost-saving deals with Mr. Baucus’s committee. Drug industry lobbyists said they negotiated a deal to contribute $80 billion over 10 years toward the cost of an overhaul with Mr. Baucus, under White House supervision, before taking it to the president for final approval. House lawmakers have said they were caught by surprise when it was announced.

Hospital industry lobbyists, speaking on the condition of anonymity for fear of alienating the White House, say they negotiated their $155 billion in concessions with Mr. Baucus and the administration in tandem. House staff members were present, including for at least one White House meeting, but their role was peripheral, the lobbyists said.

Several hospital lobbyists involved in the White House deals said it was understood as a condition of their support that the final legislation would not include a government-run health plan paying Medicare rates — generally 80 percent of private sector rates — or controlled by the secretary of health and human services.

“We have an agreement with the White House that I’m very confident will be seen all the way through conference,” a lobbyist, Chip Kahn, director of the Federation of American Hospitals, told a Capitol Hill newsletter.

Mr. Emanuel and liberal Democrats argued that the White House had worked more closely with the Senate Finance Committee because it was stepping in to break up legislative logjams. In the same way, they said, Mr. Obama and Mr. Emanuel had personally interceded to resolve a last-minute revolt by conservative House Democrats that threatened to derail a bill in the energy and commerce panel in July.

Representative Henry A. Waxman, the California Democrat who is chairman of the Energy and Commerce Committee, said Mr. Obama had assured House members that he did not intend to let the Senate Finance Committee determine the final bill.

“This is going to be a genuine conference with give and take,” Mr. Waxman said. He added: “The president has said he wants a public option to keep everybody honest. He hasn’t said he wants a co-op as a public option.”

Still, industry lobbyists say they are not worried. “We trust the White House,” Mr. Kahn said. “We are confident that the Senate Finance Committee will produce a bill we fully can endorse.”

The majority of the economists The Wall Street Journal surveyed during the past few days said the recession that began in December 2007 is now over.

After months of uncertainty, economists are finally seeing a break in the clouds. Forecasts were revised upward for every period, with 27 economists saying the recession had ended and 11 seeing a trough this month or next. Gross domestic product in the third quarter is now expected to show 2.4% growth at a seasonally adjusted annual rate amid signs of life in the manufacturing sector, partly spurred by inventory adjustments and strong demand for the "cash for clunkers" car-rebate program. Economists expect GDP growth to remain above 2% at an annualized rate through the first half of next year.

Wednesday, August 12

The tension between the business interests of the conservative-industrial-complex and the Republican party is real. There is a huge amount of money to be made by selling to a segment of the country that alienates the critical middle that every party needs to occupy to remain a national force. And so the success of the movement risks the failure of the party. And the failure of the party - its permanent isolation from power - only fuels the resentment and alienation that make so much moolah.

This is the GOP's Fox problem. You ride that fox; it eats you in the end.

The American College of Surgeons is deeply disturbed over the uninformed public comments President Obama continues to make about the high-quality care provided by surgeons in the United States. When the President makes statements that are incorrect or not based in fact, we think he does a disservice to the American people at a time when they want clear, understandable facts about health care reform. We want to set the record straight.

Yesterday during a town hall meeting, President Obama got his facts completely wrong. He stated that a surgeon gets paid $50,000 for a leg amputation when, in fact, Medicare pays a surgeon between $740 and $1,140 for a leg amputation. This payment also includes the evaluation of the patient on the day of the operation plus patient follow-up care that is provided for 90 days after the operation. Private insurers pay some variation of the Medicare reimbursement for this service.

Three weeks ago, the President suggested that a surgeon's decision to remove a child's tonsils is based on the desire to make a lot of money. That remark was ill-informed and dangerous, and we were dismayed by this characterization of the work surgeons do. Surgeons make decisions about recommending operations based on what's right for the patient.

We agree with the President that the best thing for patients with diabetes is to manage the disease proactively to avoid the bad consequences that can occur, including blindness, stroke, and amputation. But as is the case for a person who has been treated for cancer and still needs to have a tumor removed, or a person who is in a terrible car crash and needs access to a trauma surgeon, there are times when even a perfectly managed diabetic patient needs a surgeon. The President's remarks are truly alarming and run the risk of damaging the all-important trust between surgeons and their patients.

We assume that the President made these mistakes unintentionally, but we would urge him to have his facts correct before making another inflammatory and incorrect statement about surgeons and surgical care.

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That's because there isn't any. This "right" has never existed in America

While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:

2. Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits.

3. Repeal all state laws which prevent insurance companies from competing across state lines.

4. Repeal government mandates regarding what insurance companies must cover.

5. Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year.

6. Make costs transparent so that consumers understand what health-care treatments cost.

7. Enact Medicare reform.

8. Revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.

Ezra Klein is dismissive and wants to talk about the effectiveness of subsidies. Done properly, subsidies are useful for making sure the poor have some minimal level of care, but I fail to see how they would improve care for the vast majority of (non-poor) people.

Which is probably why, as Wilkinson points out, Ezra doesn't normally spend a lot of time talking about expanding Medicaid in the context of reform, because it's a separate issue. The problem of poverty, while important, does not bear on the problem of reforming care for the rest of us--which is also important.